Factors influencing smokeless tobacco use among high school adolescents in Sindh Pakistan.

Objective: To assess the use of smokeless tobacco among adolescents in high schools, and to determine the factorsthat contribute to the use of smokeless tobacco in this age group.Methodology: This cross-sectional study was carried out between October and December 2022, involving 308 participantswho were 9th and 10th-grade adolescents, aged 13 to 16 years, from four public high schools located in TalukaQasim Abad, District Hyderabad. Data were collected using a pre-designed YRBSS (Youth Risk Behavior SurveillanceSurvey) questionnaire to examine smokeless tobacco (SLT) use. Data analysis utilized SPSS version 29, involving chisquaretests and binary logistic regression analyses to evaluate the likelihood of factors related to adolescent smokelesstobacco use.Results: The study indicated that 23% of participants were actively using smokeless tobacco, with an average age of15.42 (±SD 5.6). The logistic regression analysis demonstrated that male adolescents whose parents and friends usesmokeless tobacco, who have limited health education and exposure in public environments, and who perceive comfortand appeal in using smokeless tobacco, were all significantly associated with an increased likelihood of smokeless tobaccouse among adolescents.Conclusion: There is an urgent requirement for focused interventions and public health initiatives to diminish the use ofSLT and to tackle the social influences and perceptions associated with it. Keywords: Tobacco, Smokeless, Adolescent, Health Impact Assessment